


Chasing Life

by zerostumbleine33



Category: Supernatural
Genre: Alternate Universe - Hospital, Bad Parent John Winchester, Bottom Dean, Explicit Language, Implied/Referenced Homophobia, M/M, Major Character Injury, Medical Jargon, Medical Patient Sam, Medical Procedures, Pining, deancaspinefest
Language: English
Status: Completed
Published: 2017-02-05
Updated: 2017-02-05
Packaged: 2018-09-22 08:01:09
Rating: Explicit
Warnings: No Archive Warnings Apply
Chapters: 2
Words: 18,490
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/9594758
Author URL: https://archiveofourown.org/users/zerostumbleine33/pseuds/zerostumbleine33
Summary: Castiel is the perfusionist on call when a young college kid, Sam Winchester, is brought in with Acute Respiratory Distress and needs to be put on an emergent life support machine called ECMO. His brother Dean is there with him every day, and along the way he forms a surprising bond with Castiel.Afraid of hospital rules and his own self doubts, Castiel keeps their relationship strictly in the friendship area, wary of losing his job as he falls hard for a patient’s family member, that he is pretty sure isn’t into men anyway. Either way, it’s against the rules and he’s not about to break them.





	1. Chasing Life

**Author's Note:**

> This was both difficult and easy for me to write, since a lot of it was based on personal experiences (minus the romance). For the sake of easier reading, I've skimmed over as much of the medical stuff as I could while trying to keep it as factually based as possible. I hope to bring attention to this awesome field in medicine and I hope that all the other professions are depicted in a positive light, because I am very grateful to everyone who does this kind of work!
> 
> For anyone interested, I've created a small glossary with photos [here](http://archiveofourown.org/works/9594758/chapters/21685688), to help with any of the medical terminology and just imagery that might be necessary.
> 
> A big thank you to my artist, [feministcastiel](http://feministcastiel.tumblr.com/) for her amazing art which can be found [here](http://feministcastiel.deviantart.com/art/DCPF-coffee-shop-finished-662397185) and [here](http://feministcastiel.deviantart.com/art/Dcpf-Phone-Pic-Finished-662397558).
> 
> Also, my betas who were SO great and very necessary in making sure that I didn't over or under explain things in my story. These 3 were fantastic and vital to creating a finished work: [caswouldratherbehere](http://caswouldratherbehere.tumblr.com/), [profound-boning](http://profound-boning.tumblr.com/), and [ssjdebusk](http://ssjdebusk.tumblr.com/)!
> 
> Please enjoy :)

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**December 2, 2016**

 

Sam dragged his body slowly up the few steps of the library, ignoring the sweat beading on his back and his forehead. He could hear his heart in his head and by the time he’d climbed the stairs, his chest was heaving up and down. Despite the chilly winter air and his very thin coat, he’d managed to find himself unbearably warm, his hands clammy as he gripped the straps of his backpack.

“Sam? Oh my god, Sam, what are you doing here?”

Sam turned around, the straps of his heavy backpack digging into his shoulders. He attempted a feeble smile at his friend Sarah as she strode over to him from a table in the back corner.

“I’ve gotta cram for this midterm too.” He said with a shrug, followed by a cough that shook his whole body as he tried not to meet her eye.

“You’ve had the flu for over a week, you need to be at home getting some rest,” she hissed, grabbing him by the elbow and pulling him over to a nearby table. “You look awful, Sam.”

He was too exhausted to respond, so he let her push him down into a chair. He swung his backpack onto the table and immediately regretted the amount of effort it took, as he struggled to take in more air. He’d never felt this awful in his life and he was half tempted to text his brother to tell him just how bad it really was. He closed his eyes and tried to take a deep breath, feeling like he’d run a marathon. His breath instead came in ragged and short.

“Where’s everyone else?” He managed to get out slowly.

“You’re about an hour early,” Sarah replied as she dropped her own bag down onto the table with a heavy thud.

Sam looked at her in confusion and checked his phone. He could have sworn it was 7:00 pm. Sure he’d had classes all day and then gone home for a quick nap, but how was it only six? He’d thought he was actually running late so he’d tried to jog over here from the dorm, which had turned out to be completely futile once he’d started coughing and couldn’t stop for 10 minutes.

“Are you sure you don’t want to email Mr. Singer and ask to take the exam another day? I know he’d let you,” Sarah said gently, placing her hand on Sam’s arm.

“I’m already behind in Latin,” Sam said with a groan, pulling out his books and dropping them onto the table with a loud thud. “Plus, I’m more worried about my poli-sci final and you know Dr. Henrickson wouldn’t give me an extension.”

She frowned, scrunching up her nose slightly. He loved that. Except when his vision began to swim in front of him and the room tilted on an axis. Sam tried to take a deep breath but his lungs felt like putty: useless and stagnant. Panic rose in his throat and he grabbed at the table feebly as he slid forward from his chair. He tried to breathe several times more, short and quick inhales that resulted in nothing. He felt like he was drowning, gasping for air that wasn’t available. He closed his eyes gently for just a moment, letting the exhaustion overtake him.

His body hit the floor of the library with a dull thud, echoing in the silence.

 

\----------------------------------------------------------------------------------------------------------------------------

 

Castiel Novak rolled over in bed, huffing as his hand knocked his glasses from his nightstand. He groaned as he grabbed his pager and sat up, squinting his eyes in the darkness as he read his message. It was a number he recognized well; the front desk of the Intensive Care Unit at St. Luke’s hospital. With a deep sigh he ran his hands over his face and swung his legs over the side of his bed.

Okay, so maybe it’s just a small, quick case, he hoped, and he could be back in bed before his shift officially started. He looked at his phone, illuminating his bedroom in a pale blue glow. Next to him, his dog shifted and grunted a little but otherwise remained asleep. His clock read 3:12 in the morning and he drew a long inward sigh before dialing in to his work.

 

\----------------------------------------------------------------------------------------------------------------------------

 

“His pO2’s are plummeting and he’s acidotic,” Missouri, one of the ICU nurses, said as she walked briskly beside Castiel, helping push a cart full of supplies towards room thirteen.

“What’s his story?”

“He was brought to the ER after he passed out at a study group with friends. Damn students, working so hard all the time. He’s had the flu I guess,” she said with a small shrug to her shoulders.

“ARDS?”

“It’s the season,” Missouri said in annoyance. Of course, she was right. With the turning leaves and Christmas carols, came the dreaded flu season and the patients who got so sick they collapsed and ended up in the ICU. It wasn’t unheard of, that’s for sure.

Castiel kept both hands on his cart as he pushed it inside the room, leaving damp imprints on the cool metal.

“So Dr. Talbot said we’re definitely doing ECMO?” Castiel asked, narrowing his eyes. He hated doing procedures alone, with half the staff present, most half-asleep, in the dead of night.

“She did.” Missouri paused. “Sure you got this on your own, kid?” She asked, her slight Southern drawl adding a layer of cushioning to her words. Cas tried not to roll his eyes. He was the newest staff perfusionist, which of course meant that everyone questioned him even after working there for nearly a year.

“I think I’ll be fine, Missouri,” he replied, turning his attention to the patient and running through his own mental checklist. The constant doubt from everyone else made it hard to feign his own confidence, especially when he needed it most.

The room was already beginning to fill up with nurses and a respiratory therapist adjusting the ventilator settings. He tried to ignore the pang of sympathy he felt as he noticed the patient: a young kid with long sandy-brown hair, who looked like he could be a basketball player judging by his height. His feet brushed against the edge of the hospital bed.

Cas looked away, rubbing his hands against his eyes, wishing to god he’d never bothered putting his contacts in. He turned abruptly when he heard the curtain swing open and the familiar click of the half-inch heels Dr. Bela Talbot wears every day. She was nothing if not fashionable, concise, and had an amazing proclivity for calling staff in to do procedures overnight. Which wasn’t to say she wasn’t a good doctor, but she had her quirks.

“Castiel,” she said, her green eyes piercing as she made direct eye contact with him. “We’re doing V-V ECMO, do we have the Avalon cannula?”

He nodded, pulling it from the cart next to him. “31 French would be best due to his large size.”

She nodded and stepped towards the patient, examining the area beneath his jaw, her fingers pressing gently against his neck as if feeling for his pulse. Castiel pulled his ECMO cart close to the bed and looked through the circuit one more time before the organized chaos began. He was secretly thankful that it was only veno-venous ECMO. He was there to make sure the patient’s blood drained into his circuit, was oxygenated, and then pumped back to the patient -- all of this located on one portable cart. He took a few deep breaths and went through the steps in his head again.

It wasn’t like he hadn’t done this before on his own, but it was always nerve-wracking. There was so much that could go wrong and the procedure or the patient’s condition could easily go from bad to worse. The kid was de-saturating: his lungs were unable to oxygenate his blood and they had to act quickly.

The rest was a blur of motion, wearing heavy lead-jackets and sterile gowns, all crammed into a small ICU room with a million machines. Castiel could feel the sweat plastering his hair onto his forehead beneath his scrub cap and his gloves felt too tight on his hands. Doing this procedure in the ICU room was preferable to doing it in the ER but the room was still way too small and tensions were incredibly high. At least by the end of it they wouldn’t need to move the patient again.

They placed the cannula, essentially a large hose, into the right internal jugular vein on the right side of the patient’s neck, and Castiel took a deep breath as it was his turn to play his part. He removed the venous line clamp first on his circuit, and turned up the flow on his machine. Then he slowly removed another clamp from the patient’s arterial line on his circuit, which is where the newly oxygenated blood will return to the patient.

It wasn’t like in the movies, where the patient instantly looked better with a warm pink tone and immediately opened his eyes. It was a slow, gradual process, with the kid heavily sedated and a million lines coming out of him. The whole procedure took over an hour, with everyone coordinating to ensure proper cannula placement and making sure the patient was stabilized.

It was helping though; his saturations were improving and that was all they needed for now. Just enough to give the kid a shot to pull through this. Castiel wiped the sweat from his forehead and made sure to adjust his pump so that it was angled close to the bed as soon as the room cleared out. The hardest part wasn’t even over yet.

“Does he have any family?” Castiel asked Missouri, once things had died down a bit and the patient seemed stable enough. It was nearly six in the morning; somehow the hours had flown by.

“Far as I know, he’s got a brother who was his emergency contact. Pretty sure he’s driving in from somewhere in Kansas.”

Castiel glanced at his watch. It was at least an eight hour drive, if he could recall correctly from a road trip he’d taken with some friends in college. He sighed and took his scrub cap off, running a gloves hand through his messy hair. “So it’ll be a while.”

Missouri gave him a look, as if to say ‘I’d plan on being here all night, honey.”

Cas knew the look fairly well. He was a single guy in his late 20’s, no kids, no ring on his finger, and the newest guy on staff. He ended up taking the overnight on-call shift a lot. Not that he always minded it so much, but it was starting to wear him down. They’d lost a few patients recently and he’d started to get that nagging feeling of ‘why am I doing this?’ in the back of his mind.

“Castiel.”

Cas turned around, surprised to see Dr. Talbot back in the room so soon.

“How’s he doing?”

“Everything seems stable, his pO2 is in the 50’s and his venous saturation is 86,” Castiel said as he turned his monitor over to the doctor.

“And his sedation?”

“Still paralyzed and fully sedated,” Missouri replied as she draped a few more blankets over the patient.

“I’m glad to hear it,” Dr. Talbot said before glancing back at Castiel. “His brother’s here.”

“Already?” Castiel asked, blinking a few times in surprise.

“He was already halfway here to visit his brother when we first called him.” She said, annoyed at being interrupted. “If you wouldn’t mind speaking him about what we’re doing here,” she said motioning towards the ECMO machine.

He knew it was coming, the dreaded interaction with the patient’s family. The whole reason Cas had opted not to go to medical school (okay so one of several reasons) and Dr. Talbot was the only doctor who frequently asked her perfusionists to speak to family members.

“Sure,” Cas said with a shrug. It wasn’t like he could really refuse.

“He’s in the private waiting room,” she said as she followed Cas out of the ICU room. “He’s pretty shaken up.”

Oh great, Castiel thought to himself. He was not the best at dealing with emotional family members and tended to drift off into explaining the technical side of things and then being hit with the question, ‘but he’s gonna make it right?’ to which he had no real answer. He knew that Dr. Talbot thought that the description of ECMO itself was better described by the perfusionists but he always suspected that she also hated dealing with family members for too long.

He took a deep breath and knocked on the door before opening it, stepping into the dimly lit room, painted a calming pale blue with a small couch on one side and a few other seats around it.

The man on the couch jumped up, his face pale and drawn. Castiel noted the small shake to his hands as he put his phone in his pocket and stepped towards him.

“Castiel,” he said, offering his hand.

“Dean, Dean Winchester,” the other man blurted out. “I’m Sam’s older brother.”

Cas nodded and motioned for Dean to take a seat again. He sat in the armchair opposite him and pulled it closer. Cas couldn’t help but notice that Dean was attractive, even in the poor light and with all the color drained from his face. It was inappropriate but Cas noticed it anyway. He cleared his throat nervously.

“I’m the perfusionist,” Castiel said slowly, watching to see Dean’s reaction. He got a blank and confused stare back. “That’s okay, not many people know about my job,” he said with a small chuckle.

“Sorry,” Dean said shrugging his shoulders. “I’m a mechanic, all of this is way above my head.”

“Okay, I’ll try to explain everything the best I can, and I know Dr. Talbot spoke to you as well” Cas said, giving Dean what he hoped was a reassuring smile. It seemed to work, as Dean leaned forward and folded his hands in front of him on his lap, as if he was eager to learn.

“I run the heart-lung machine for open heart cases, that’s my primary job,” Castiel began to explain. “But another big part of my job is helping with ECMO, which is what your brother is on.”

“So is something wrong with Sammy’s heart?” Dean asked, his voice rising in concern.

Fuck. This is why he was awful with this. Castiel started again. “No, sorry, okay. Your brother’s heart is fine. Which is a good thing.”

Dean let out a large sigh.

“But his lungs are...” Cas paused, grasping for how to say it gently. “Well, they’re shit,” he finished, opting to just be frank about it. “For now.”

“So this thing, this machine, it’s going to make his lungs better?” Dean’s eyes were wide with worry.

“Well, it’s going to help his lungs rest so that they can hopefully improve,” Cas replied with a shrug. “My machine is doing the work of his lungs for him.”

“So how long does he need to be on the ECO thing?” Dean asked, furrowing his brow.

“ECMO,” Castiel corrected. “Extracorporeal membrane oxygenation.”

“That’s a mouthful,” Dean replied with a forced smile.

“It is.” Castiel shrugged.

“I just don’t understand though, how did this happen?” Dean looked at Castiel with pleading eyes. “I mean, the doctor, she explained it but I just don’t understand, he’s a healthy kid.”

“We’re going to try to find out,” Cas replied. “But this happens sometimes even with relatively healthy people. He may have gotten the flu and it just spiraled from there into pneumonia, which damaged his lungs.”

“But this will make him better, right?”

Cas tried to keep from rolling his eyes. It wasn’t that he was trying to be insensitive, it’s just that it was the one question he couldn’t answer. He’d learned the hard way not to promise a recovery.

Castiel leaned forward and placed his hand on Dean’s shoulder, patting it gently. “He’s very sick but this is giving him a fighting chance, okay?”

Dean sighed and looked down at his hands. Cas watched him take a few deep breaths that shook his shoulders. When he looked up, his eyes were glassy and his fingers tapped idly at his knees.

“He’s the only person I’ve got,” Dean said quietly. “I can’t lose him.”

Castiel nodded slowly, recognizing his cue to leave. There wasn’t much else he could do. Of course they’d take great care of his brother but that was all he could promise, that they’d try.

“I assume you’re staying the night,” Cas said as he stepped towards the door.

“I’m not moving from this hospital as long as Sammy’s here,” Dean replied with his mouth set in a firm line.

Castiel simply nodded in agreement. “I’ll send a nurse over with some pillows and a blanket,” he offered as his last consolation. It wasn’t much but he could at least make sure the poor guy could try to get some shut eye until it was cleared for him to visit his brother.

 

\----------------------------------------------------------------------------------------------------------------------------

 

**Dec 5, 2016**

 

The next two days flew by, with Castiel busy in the OR for most of them. He had a few nights off-call, during which he slept and tried to get in some much needed time to read for fun. It was a concept that had been lost on him during his college years, and then the two years of graduate school as well. He was 27 and finally settling into his own routine, although lacking in the relationship department.

Saturday morning 6:00 am shift was never his favorite. He needed to wake up with enough time to shower quickly and at least pack a cup of coffee for himself because he just couldn’t function without it. So at five he was up, slamming his hand onto his nightstand looking for his phone in the darkness. It was a routine he was used to.

He took his dog Ahri out, a small terrier mix that he’d adopted a year ago when he’d first moved out to Chicago from Boston. He’d found the apartment lonely, as well the city. He’d meant to get a cat, but this little puppy had escaped from her pen and run out to the main lobby with a devilish look in her eye and jumped straight into his arms, licking his face and nipping at his nose. It was pretty much love at first sight, so he took her home.

By the time he rolled up to the hospital, he felt more awake, with a warm travel mug in his hand as he slung his bag over his shoulder. He’d biked over that morning, enjoying the last few days of Chicago fall, before the cold winter hit. They’d been lucky so far with no snow yet, which meant he could still get to work within 30 minutes even if he was taking his time.

He wasn’t sure yet of his assignment for the day. They had two patients on ECMO: a little red headed girl named Anna who had cystic fibrosis, and the college kid Sam. If he was honest with himself, he was a little wary of sitting ECMO for either one but at least Sam didn’t seem to have a steady stream of family members going in and out, just the one brother at his side.

Castiel jogged up the steps of the lobby to the second floor, stopping briefly in the office to check his schedule. He smiled when he saw that Charlie had put her name next to the room with the young girl. Charlie was probably his favorite coworker, and she had no problem dealing with family members, in fact she had a knack for making people feel at ease and welcome.

He took one last gulp of his coffee before placing his stuff down on the desk, adjusting his pale blue scrubs and stepping out towards the ICU. For a big hospital, everything was fairly easy to locate. Surgery and ICU were on the same floor, and coincidentally so was the perfusion staff office and the on-call room for them.

Castiel knocked gently on the door before stepping in, sliding the glass door open further and pushing aside the curtain. He noticed Dean in a chair in the corner, his eyes closed. A blanket was tucked gently around his shoulders and a pillow lay against the chair and wall behind him.

Cas made eye contact with Tessa, the nightshift nurse and gave a small wave. They spoke in whispered tones, exchanging the report from the night. Everything had been pretty stable so they’d begun to wean Sam’s sedation. He’d been on ECMO for four days.

“And his brother?” Cas asked hesitantly.

“Don’t try to get him to leave,” Tessa said with an annoyed huff. “He’s a stubborn one.”

Cas tried to suppress a small grin. From the few minutes he’d spent with the man, that didn’t surprise him one bit.

“How long has he been asleep?” Cas asked, eyeing Dean again.

Tessa shrugged her shoulders. “About an hour maybe? I think it’s the first time he’s closed his eyes since he’s been here.” She tugged a sweater on over her light blue Christmas scrubs with penguins on them. It was silly but it was that time of year.

Cas looked over at Dean again. He knew X-ray would be in soon to take some shots to make sure the cannula placement was still good, with the cannula running from the jugular vein down through the right atrium of the heart. Only part of the cannula was visible from the outside and then connected like a hose to his circuit, with the red blood visible. After X-ray it would be time to draw morning labs and by the time that died down it would be close to eight, meaning the doctor’s would be doing rounds.

Dean snored lightly and Castiel frowned. He felt bad for Dean, he couldn’t help it. All of this was normal to him, but he couldn’t imagine being a family member and seeing all the lines full of blood leaving and entering the body of someone they loved. He shook his head slightly to remind himself to pay attention to what Tessa was saying.

Once Tessa left, Cas took over, inspecting the circuit and checking all of Sam’s lines. He brushed Sam’s hair away from his forehead and looked at him for the first time really. He had a strong jaw, straight nose, and clearly was someone who was in shape. The guy was tall, like extremely tall. In the bed though, he looked small and frail with a million tubes coming out of him. It had only been a few days but Cas knew his muscles would soon begin to atrophy if they didn’t try to get him up and moving around. He felt for him, he really did.

“He needs a haircut, right,” a groggy voice said from behind Cas.

Castiel turned around quickly in surprise. Dean stretched his arms out slowly above his head and then dragged his hands down his face, rubbing at his eyes. “I didn’t mean to fall asleep,” he said.

“Tessa said you’ve barely slept,” Cas replied as he stepped towards Dean. “And I hate to break it to you but we’re going to kick you out shortly to get a few tests done.”

Dean waved his hand. “I know, I know.” He narrowed his eyes at Cas. “I know we met but I’m sorry it’s just been a nightmare of a few days and so many new faces.”

“It’s Castiel,” he interrupted. “It’s okay if you need to look at my badge too,” he explained as Dean’s eyes wandered towards his waist where his badge was clipped. Something in the way he did it sparked a slow heat in Cas and he turned away quickly, ignoring the small flush of his cheeks.

Dean cleared his throat behind him. “So, uh, Tessa left, or?” He trailed off.

Castiel turned back around. “It was shift change. We were quiet about it.” The last thing he needed was to inadvertently flirt with a patient’s family member and get himself kicked off the case.

“So they change out one pretty nurse for another one then, eh?” Dean smirked as he shrugged into his jacket.

Castiel didn’t know whether to be surprised, amused, or annoyed. “Not a nurse, a perfusionist,” he replied with an accusatory tone, pointing to his badge again.

This time, he noted the flush on Dean’s cheeks as his eyes traveled slowly down Castiel’s body and then quickly away. Cas knew he should feel ashamed but he wasn’t one to back down from a challenge.

A knock on the door saved him as Kali, the X-ray tech, poked her head in with a smile.

“I guess that’s my cue to leave,” Dean said solemnly as his gaze returned to his brother and his brow furrowed again in concern.

Cas chastised himself internally for forgetting for even one moment that this was a patient’s family member who was under incredible stress. He didn’t need to play games, no matter how inviting Dean’s attempts were. He glanced over at the white board and noticed that Dean’s number was scribbled in the corner.

“I’ll give you a call once we’re all done in here,” he said with a reassuring nod.

Dean looked back at his brother once more before pulling out his phone and stepping out into the hall, his face looking much more weary and drawn. Sometimes Cas hated his job.

 

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It was about five in the afternoon and Sam was still stable, not awake but his sedation had been weaned. Cas watched as Dean sat with his chair pulled close, holding his brother’s hand and speaking in a quiet voice.

The hardest part about doing a full shift in one patient’s room is that while you were busy for a lot of the time, you were also bound to end up sitting and doing monotonous charting on the computer, or worse, chatting with the family members. Castiel had spent much of the day trying to occupy himself in order to not catch himself staring at the tender way Dean took care of his brother, worry lines etching themselves into his forehead.

Every so often, one of Sam’s feet would move and Dean would glance over at Cas with an excited expression. Cas would nod and remind him that coming out of sedation would take some time but that it was a good sign. In between monitoring his vitals, checking the circuit, and administering fluids whenever it was needed, their eyes would meet and Cas breath would catch in his throat at the way Dean looked at him with a million questions in his eyes.

The day had gone relatively smoothly. Sam’s cannula placement was still great, although his flows had gone down slightly on the pump, they overcame it by giving him 500cc of fluids and the flows came back up. It seemed like things were on track now: his lactate levels had come down steadily all day. If Cas was a betting man, he’d say that Sam really seemed like he had a good shot at recovery. Dean looked like he was waiting for Castiel to say it out loud, but he knew he couldn’t. Not this time.

As far as Cas knew, the plan was to slowly wean Sam from sedation, eventually remove his ventilation and a trach in (a tube in his windpipe for emergencies) and then get him up and walking. It was ambitious. It was how things worked with ECMO. Things either moved quickly or not at all.

“So I’ve been making him all these promises, if he gets better,” Dean announced slowly, as he adjusted Sam’s blankets for the millionth time that day.

Cas raised his eyes from his computer to look at Dean. “Oh, really?”

Dean looked like he needed to talk, that sitting cooped up in a cramped room was driving him nuts. His legs bounced up and down beneath his seat and his eyes kept wandering from one large piece of equipment to the next. Castiel decided he would take the bait.

“What kinds of things are you promising him?”

“Well you see, I’ve got this car, handed down from our dad. She’s a gorgeous ‘67 black Chevy Impala.”

Cas nodded as if he had any idea what Dean was talking about. He biked to work, walked, or took the train. He’d never owned a car in his life.

“So of course Sammy’s not allowed to drive her, or pick the music,” Dean said with a grin. “He’s got shitty taste in music, but don’t tell him I told you that.”

Castiel couldn’t help but grin slightly. “Then you promised to give him this car?”

“Oh hell no,” Dean said loudly with a laugh. “I’ll let him drive her every once in a while, and maybe even pick the music as long as it’s not Taylor Swift.”

Cas chuckled, “That sounds fair enough.”

Dean ducked his head down, hiding a small smile. The guilt was written all over his face.

“You know, it’s okay to smile or laugh while he’s in here,” Castiel said in a soft voice.

“It feels wrong.”

Cas shrugged his shoulders and sat back in his chair, feeling like an extremely under qualified therapist. “I think he’d want you to not beat yourself up for just trying to get through the day any way that you can.”

Dean looked back at his brother with a gentle smile. “I know you don’t know him, not yet, but that sounds just like him.”

A knock the door alerted them to the time and Cas offered one last smile towards Dean, before he prepared to go over the shift change and finally head home. As he stepped out the door, Dean’s voice called from behind.

“Hey, Cas.”

Cas turned around, surprised to hear him use his nickname.

“Thanks.”

They didn’t really need more and Cas wouldn’t have even known what to say. Twelve hours is a long shift, and yet he felt like he could have sat in there a bit longer listening to Dean talk about his brother. The love there was apparent and it stirred up feelings inside that he’d long suppressed about his own family.

He greeted Tessa with a smile as she took out her notepad and a pen, ready to go over the day’s progress.

 

\----------------------------------------------------------------------------------------------------------------------------

 

**Dec 7, 2016**

 

Castiel had drawn the short stick again, ending up with the overnight shift for ECMO and he felt like he hadn’t left the hospital all week. The only good thing was that he was assigned to Sam again. The other girl, Anna, had passed away the night before but things kept moving as usual and they had put another guy on ECMO only a few hours later: a burly man in his 30’s named Benny.

It had been a few days since Sam’s sedation had been weaned, but he was still very out of it. He’d begun to move his arms and legs, which was a good sign but he wasn’t out of the woods yet. He’d open his eyes briefly and look around in confusion before closing them again and falling asleep.

He’d been agitated during the day, causing his heart rate and his breathing rate to increase. It was expected, but it still put everyone on edge. He jumped between needing various drips to increase and then decrease his blood pressure. Cas couldn’t imagine how much it must worry Dean.

When Cas entered the room, Dean stood up immediately, patting his brother’s shoulder gently. He looked exhausted, which wasn’t any different from how Cas had ever seen him, but his eyes were red rimmed and one hand was clenched into a fist.

“Is everything alright?” Castiel asked, immediately realizing what a stupid question it was.

Dean looked over at Sam and sighed, throwing his cell phone onto the bed. “Nothing out of the ordinary. Finally got a hold of our dad.”

Castiel noticed the cold, sharp cut to his words, and the way Dean’s mouth turned down in disgust. It hurt him, because he could recognize that feeling. He hadn’t spoken to his own father in years. He reached out a hand to place it on Dean’s shoulder, but pulled it back again awkwardly.

“I’m sorry.”

Dean looked back at Cas, his voice low. “He’s not even coming out here, says Sammy will be fine, that he’ll swing by once he finishes up some work he’s doing in Wisconsin.”

Castiel looked over at the monitor as it began to flash slightly. Sam’s heart rate had increased again and his hands grasped at the bedsheets. They’d had to restrain him, to keep him from pulling at his ECMO cannula or his intubation tube. It was hard to see a patient restrained to the bed and confused about why they couldn’t move.

Dean stopped talking and looked down at his brother, shaking his head. “That happened when I talked to Dad on the phone. It was like he knew I was upset.”

“That’s normal,” Cas said in a soothing tone. “He’s still in there, on some level he knows what’s going on.” Castiel’s eyes met Dean’s. “That’s a good sign.”

Dean took a deep breath and ran his hands down his face slowly before checking his watch. “Is the cafeteria still open?”

Castiel shook his head. “Sorry, closed about 30 minutes ago.”

“Fuck.”

“I’ll be right back,” Cas said as he stepped out of the room, waving over one of the ICU nurses, Jo.

She walked over, rolling her eyes jokingly. “What do you need, Novak?”

“Are you busy?”

She glared at him. “Of course I’m fucking busy.”

Shit. That was a dumb way to word it. Cas looked back at her and gave a small smile. “If I asked nicely, would you possibly have time to keep an eye on Sam if I went to get some food really quick?”

“Didn’t you just get here?” She accused.

He looked back towards the room, at Dean pacing and taking his phone out and putting it back in his pocket. “I forgot to pack food,” he shrugged.

“Fine.” She playfully punched his shoulder. “But only because I think the brother is really cute.”

“Dean?” He said, in all too obvious agreement.

“Duh.”

Cas smiled and thanked her, grinning to himself as he turned away, as he declined to tell her that Dean wouldn’t be in the room with her.

“Let’s go get food,” he said waving at Dean. “I’ve got 30 minutes to sneak you into the doctors’ lounge.”

Dean looked up, his eyes wide.

“Don’t worry about Sam, a nurse is going to watch him until we’re back.”

It didn’t take much more convincing than that. Dean looked back at his brother once more and then followed Cas out of the room.

As they strode together down the hall, Castiel realized just how tall Dean was. Cas wasn’t a short guy, but Dean was still slightly taller than him. He was so used to seeing Dean hunched over Sam’s bed, his shoulders drawn. He’d found Dean attractive enough, with traditional good looks: a strong jawline, military-cut light brown hair, and a straight nose. But outside of the dim lights of the ICU, he was even more striking.

They stopped in front of the elevator and Cas glanced over at Dean who was looking around the hall, unsure of where they were going. His eyes were still bloodshot and red-rimmed but Cas noticed just how green they were. His eyes traveled quickly down Dean’s body, his broad-chest and well-toned arms beneath a thin gray Henley. Cas turned back towards the elevator doors as they opened, blushing slightly.

“So. The doctors’ lounge, huh,” Dean finally said, breaking the silence in the elevator.

“It’s just a few floors down,” Castiel replied. “I guess sneaking you in isn’t really the right term, since I’m sure no one would say anything anyway.” He chuckled slightly.

“Way to kill the excitement.” Dean raised his eyebrows in a suggestive manner.

Before Cas could think of a witty reply, a loud rumble came from Dean’s stomach and his cheeks flushed slightly in embarrassment.

“You should just be worried that there won’t be any food left,” Castiel replied, stepping out of the elevator as it reached their floor.

As he’d expected, there was no one else in the lounge, and save for an empty rack of Keurig cups, the fridge was still fairly well stocked.

Dean walked around slowly, peering through the two fridges and then the cabinets full of cereal cups and protein bars.

“Grab whatever you want,” Cas said with a wave of his hand as he opted for a protein bar and a bottled water.

He chose a table by the window that overlooked the Chicago skyline. It wasn’t a bad view. He turned around as Dean sat down across from him, dropping a boxed BLT sandwhich onto the table, a bag of chips, a protein bar, and a Mountain Dew.

Dean looked up sheepishly. “Haven’t actually eaten since yesterday.”

“No judgement from me, man.” Cas replied smiling. It wasn’t like he was a health nut or anything, but he’d seen enough clogged arteries to scare him away from sugary drinks and salty snacks, whenever reasonable of course.

Dean dug into his sandwich first, moaning around the first bite. “I’m sure under normal circumstances this would taste like shit but damn I didn’t realize how friggin’ starving I am.” He talked with his mouth full, unapologetic.

Castiel laughed as he opened his protein bar and took a bite.

“I know the feeling. I once worked a double and forgot to eat until the next morning. The only thing left in the cafeteria were runny eggs and some soggy biscuits.”

“That sounds delicious,” Dean said with a chuckle.

“I ate two plates full,” Castiel replied.

“This doctor shit is pretty good though,” Dean said around his last bite of his sandwich. “They don’t give them the crap food, right?”

Castiel chuckled softly, his eyes drawn towards the door as it opened slowly and he heard the familiar click of heels.

He cursed under his breath as Dr. Talbot strode over to their table, grabbing an apple from a basket on the counter.

“Castiel,” she said with a nod, before her eyes traveled towards Dean. “Mr. Winchester, correct?”

Dean looked towards Cas, his mouth full of food and his eyes wide. It would be comical if not for the fact that Cas was sure he was about an inch away from getting written up.

Dean nodded slowly and stood up, wiping his hands off on his pants. “Dr. Talbot, it’s nice to see you. Thank you again, for taking such great care of my brother.”

Cas gathered the rest of their food, shoving it into his coat pockets.

“I’m glad to see that you’re also being so well taken care of it,” she said with a smile that didn’t reach her eyes.

It wasn’t like perfusionists weren’t allowed in the doctor's’ lounge, that was more of a grey line. But you certainly couldn’t bring in patients or family of patients. It was kind of an unspoken rule, a safe place for the staff to be able to come and speak freely or complain about their day, which many times included complaining about other staff and patients.

“I’m sorry, we were just grabbing some food really quick in here, really. I was starving and I mean about to pass out from hunger so Cas was just helping out,” Dean said quickly, flashing Dr. Talbot his brightest smile.

She glanced over at Cas in annoyance. “Don’t do it again, Novak.”

He fought the desire to tell her to fuck off and nodded, following Dean towards the door. It wasn’t like him to break the rules or to feel so damn obstinate about it but something in him felt protective of Dean, that maybe bending the rules should be okay. He knew it was wrong but he’d gotten attached to Dean.

Once they were safely inside the elevator, Dean turned to Cas with a smirk on his face. “She’s hot and I’m glad as hell that she saved Sam’s life, but damn she’s got a stick up her ass.”

Castiel laughed but his heart sank slightly. Dean thought she was hot, which meant Dean was straight. Dean liked women, and even though Cas would lose his job if he even entertained the idea of a relationship with Dean, a small bubble burst inside his chest and he looked down at the floor, dejected.

So much for that.

 

\----------------------------------------------------------------------------------------------------------------------------

 

**December 12, 2016**

 

Castiel had successfully avoided taking Sam’s case for a week. He was off ECMO rotation for a few days, spending his time in the OR where he felt most comfortable. At home, he took Ahri for walks in her fleece sweater as the first few snowflakes fell. It was winter in Chicago and he’d locked up his bike reluctantly, in his building’s storage and refilled his card to take the train to work.

It was back to a normal routine, although it was a little boring, it worked for him.

Until he got in today, and saw his name crossed off the open heart for the day and moved over to the ECMO shift again.

“What the hell,” he said out loud, dropping his bag onto the desk. Charlie walked in at just that moment and gave him an apologetic smile.

“Zachariah’s here today,” she said rolling her eyes. “He wanted the open heart so I had to shuffle some things around. You’re keeping your same shift but you need to sit ECMO and I woke up at the ass crack of dawn for no reason because now I need to cover the night shift.”

Zachariah, their boss who only worked cases few and far in between but floated through several hospitals in Chicago and in the suburbs, only spending enough time in each place to vaguely fudge the names of his staff members. Castiel hated him.

“That sucks,” he said, feeling slightly worse for complaining when she’d worked hard to make the schedule work for everyone else besides herself.

“If it helps, you’re with Sam Winchester again,” she said gently.

“Great,” he replied, turning around to grab his ID from his bag.

“What happened?”

“Nothing.”

Charlie crossed her arms in front of her chest. “I thought you liked him, and his brother’s been asking about you.”

Cas paused briefly before returning to digging through his bag for a pen. “Dean is great. I hope Sam gets better quickly.” He didn’t add that he hoped Sam would recover, and get out of there and take Dean with him so he could forget the shame of flirting with a patient’s family and then realizing it was all one sided anyway.

“That’s an awfully succinct way of putting it,” Charlie said as she rolled her eyes. “Look, you’re not the only one who thinks Dean’s a total babe.”

Castiel looked over at her, raising one eyebrow.

“Okay, so I don’t personally think that but, you know, nurses talk.”

Cas couldn’t help but chuckle slightly. “I’m fine Charlie, I don’t mind taking the case for today.”

Charlie narrowed her eyes at him and pointed one finger at his chest, “I’m here if you want to talk. You shut people out too much.”

Castiel tried not to let her words sting as the door closed behind her. She was right, of course. Charlie was probably his closest work friend and even then, they’d only hung out a few times. She knew he was gay, if only by close deduction and some prompting from Charlie’s girlfriend Dorothy who had had too much wine and openly asked him one night. It wasn’t something Cas advertised. Certainly not with how his family had responded when they found out.

He shrugged into his white coat, smoothing it down over the front of his chest. He rarely wore it, it was stiff and uncomfortable. The upside was that it made him less approachable, with a formal look to it. He hoped it would work as his armor for the day as he made his way towards the ICU and Sam (well, and Dean).

In the days that he’d been away, Sam had woken up and generally kept showing signs of improvement. Castiel was happy for them, if not a little anxious to now deal with a conscious patient who would be watching his every move.

Cas stepped forward into the room, adjusting his white coat once more. He couldn’t help the grin that threatened to take over his face as Dean leapt up from his chair the moment he noticed Cas.

“Cas!”

“Hello, Dean.”

Dean grinned widely and motioned for Cas to step closer to the bed. “You can finally meet Sleeping Beauty here,” he joked with a wink at Cas, his eyes seeming to linger on his white coat in appreciation.

Cas nodded but ignored Dean’s charms, addressing Sam first and speaking slowly but clearly for him. “Hi, I’m Castiel, the perfusionist who will be in here with you today.”

Sam blinked and his eyes traveled back towards his brother. He was still intubated, until they could fit him in to get a tube placed in his trachea. In all honestly, having to wait to fit into the busy OR schedule. The doctors were still debating about even needing to do it but it was a safety precaution, so for now, Sam was still unable to talk.

Dean grinned and looked back at Cas. “I explained this stuff to him as best as I could,” he said with a small shrug but his joy was apparent. His mouth had a near constant upturn at the corners and his shoulders were relaxed. He kept touching his brother’s shoulder, making eye contact as if to make sure Sam were still there and alright.

“It’s nice to meet you Sam,” Cas said with a reassuring smile. “I’m just going to check over the ECMO circuit here and then I’ll let you rest.”

Sam blinked a few times, fighting the urge to nod his head, with the cannula still placed in his jugular. A rehab nurse would be in shortly to begin the process of ambulating him, getting him sitting up in a chair and stretching out his muscles.

He looked better already and Cas noticed he had hazel eyes that kept glancing around the room and back and forth between his brother and Cas. Despite the dark shadows under his eyes, his sunken in cheeks, and dry lips, Cas could tell that Sam was also a fairly attractive man. From what Dean had told him, his brother was smart as well, studying to go to law school. Cas knew the feeling well, of being overworked and ignoring warning signs of personal health issues.

Dean stepped over to Cas, at the foot of the bed where he was inspecting the circuit with a flashlight. He was worried about the small clots that had begun to form, but it wasn’t something to freak out about yet. He furrowed his brow as he checked both sides of the oxygenator, making a mental note of how large the clots were and to check again before his shift was over. He ignored Dean, glancing only briefly at Dean’s old brown boots and then back at his circuit.

“Were you off for a week?”

He whispered it quietly, leaning forwards towards Cas’ ear. The question was innocent enough. Dean hadn’t seen Cas and assumed maybe Cas had some time off. And yet it sent shivers down his spine, as he could feel Dean’s breath on his ear.

Cas took a step back, adjusting his coat again. “I wasn’t off. I was busy doing open heart cases instead of ECMO.”

Dean leaned back against the wall, “So you rotate around different shifts for like heart surgeries and ECMO?” He had an easy grin on his face as he crossed his arms across his chest.

“Something like that.”

His lips pursed slightly as he looked at Cas, their eyes meeting briefly before Cas looked away again.

Dean got quiet, his eyes following Castiel as he began to flip through Sam’s chart and occasionally write in it. Cas could feel Dean’s eyes on him and he tried to suppress the blush that crept across his cheeks and how uncomfortable it made him to be watched, especially by Dean. He looked up at Sam and remembered that Sam was also watching the two of them closely, his brow furrowed.

“Are you pissed at me?”

“Excuse me?” Castiel blinked a few times innocently. It wasn’t his job to get emotionally attached, to develop a crush on a patient’s family member and then have to push them away just to get his job done. He could do his job without getting attached, without the flirting, and without talking to Dean.

Dean stepped over, close to Cas, but not touching him. It made Cas’ heart race.

With his back facing his brother, Dean spoke quietly. “Is this because I got you in trouble? I swear, I’m really sorry.”

Cas couldn’t help the small chuckle that came out of him. He wished it was just that. He wished it wasn’t that he longed to reach out and wrap his arms around Dean’s neck and kiss him hard. Or that he had a knack for crushing on straight guys, which only made sense because he always wanted what he couldn’t have.

“I’m not mad at you, Dean,” he replied coolly. No, I’m mad at myself, he thought.

His heart softened as Dean backed up slightly, his face drawn and solemn. “Okay, well, you know, I told Sammy how you took the best care of him and of me, you know. So. I just wanted him to meet you.”

Castiel nodded, wanting to put a hand to Dean’s shoulder but he resisted. “I was just doing my job.”

 

\----------------------------------------------------------------------------------------------------------------------------

 

By the time the afternoon rolled around, Cas’ white coat hung from the back of his chair as he sat at the small computer in the room, charting occasionally.

Sam had begun to doze off an hour earlier, exhausted from the task of sitting up. Recovery was a slow process. Cas still had been unable to read Sam, which surprised him. Most patients were very obviously anxious about the lines coming out of them, or the occasional one was just so interested in everything and motioned around for more information. Sam was quiet though, almost calm in a way.

Where Dean seemed to wear his emotions on his sleeve, Cas couldn’t get a good read on his brother. Although he did perk up when one of the nurses, Jess, came in to help with getting Sam sitting up, while Cas watched all his ECMO lines. Dean had of course made a few crude jokes about Sam in his hospital gown, which earned him a glare from his brother.

However, once Sam had fallen asleep, Dean had sunk into a chair and let out a large huff of air. Cas could relate. All the steps of recovery were hard, even for the family. One small thing could go wrong and set everything back. Dean had been a nervous wreck as he was ushered out of the room during Sam’s rehab time.

Castiel looked up briefly to watch Dean as he flicked the TV on, turning the volume low. The dim light from the screen hit Dean’s cheeks and his long lashes made shadows on his face. He grinned slowly as he put the remote down in his lap and leaned back in his chair, his arms behind his head.

Cas looked up at the TV and groaned. Dean had put on Dr. Sexy, M.D., a hospital serialization that was more soap opera than reality. That wasn’t to say that Cas hadn’t watched most of it until his favorite character was killed in a plane crash several seasons ago.

“You can’t tell me that you work in a hospital and don’t watch this,” Dean said as he noticed Cas looking at the TV.

“I can tell you that I work in a hospital enough to not watch anything related to the hospital when I’m off.”

Dean rolled his eyes. “That’s no fun.”

“Plus, most of this is so inaccurate,” Cas replied with a wave of his hand.

“You’ve never had a staff syphilis breakout?” Dean said with mock surprise.

“Nor have I had a tumultuous relationship with a coworker that resulted in using the on-call room.”

Dean looked over at him and raised his eyebrows. “Good-looking guy like you...never hooked up in the on-call room? Really?”

Castiel flushed slightly and diverted his eyes towards the TV again. “I just haven’t had the occasion.”

His heart fluttered in his chest and the words ‘good-looking’ hummed around in his head. It was silly and he felt like a schoolboy with a crush but he held onto that small thing, just one small piece of something.

He looked back over at Dean, whose eyes were once again glued to the television as Dr. Sexy himself strode onscreen, wearing his cowboy boots which Cas found completely silly and altogether non-sexy. However, he couldn’t deny his own crush on Alec, the bad boy with a heart of gold and a troubled past. Cas ignored the urge to look over at Dean again. He knew he had a type.

 

\----------------------------------------------------------------------------------------------------------------------------

 

**December 14, 2016**

 

Castiel’s hands gripped the side of the ICU bed and the ECMO cart as they pushed Sam quickly towards the OR, alarms sounding on the portable monitor.

“What the fuck happened,” he hissed at the nurse jogging to catch up to them with Sam’s chart.

“Don’t act so high and mighty Clarence, you’re not the only one around here who cares about our ECMO patients,” she spat out. “He started to desaturate again, his inspiratory rate increased and by the time the respiratory guys got here, it sounded like Sam was gagging on his trach.”

“Why the hell wasn’t I paged?”

Meg tossed the chart on the end of the bed as she helped push the bed down the hallway. “Because you’re not the perfusionist for this case today,” she said, exasperated. “I only called you because his brother wouldn’t calm down until I did.”

Cas tried to ignore her probing look, just as he ignored her every time she called him a different name as if they hadn’t both started working here at the same time together last year. He also couldn’t help wondering why in hell it was taking his co-worker, Michael, so damn long to get to the hospital.

“Who placed the trach yesterday?” Cas was kicking himself for having the day off, for enjoying it and spending most of the day curled up on his couch with his dog, marathoning Battlestar Galactica. He felt guilty.

“Who do you think? That asshole Crowley. He’s always in a rush to get out of here.” It wasn’t a secret that Meg hated him. In fact, most of the staff hated him. His work was sloppy, his patient’s always bled, and he was the least likely to answer the phone in the middle of the night if a patient was spiraling.

Castiel grimaced as he looked over at Sam, his face colorless. He’d only gotten there in time to see Sam get sedated once more in an effort to calm his breathing. He’d looked like he was choking on his trachea tube, which of course wouldn’t make sense unless it was placed wrong. Which was the unspoken concern, along with the warning lights that said lawsuit.

They moved quickly once they entered the OR suite. The whole reason they had moved from intubation to tracheostomy was a safety precaution in case Sam de-saturated for any reason, they’d have an open airway. The trach wasn’t supposed to be the thing to cause a problem. Cas watched as the anesthesiologist fumbled with it, trying not to misalign it any further.

It wasn’t like Sam’s body wasn’t being oxygenated, that was the whole point of ECMO, but the violent and fast breaths he took had increased his metabolic rate exponentially as he became more agitated. His saturations had dropped and they were afraid of bleeding around the trach site. Cas was more afraid that all the movement had misaligned the cannula in Sam’s neck, which could be a much larger problem.

He took a deep breath and began to collect his thoughts, ignoring his own nagging worries about Sam and about Dean. He hadn’t seen Dean. By the time Cas arrived, Dean had been ushered away into the family area. He couldn’t think about that.

Instead, he focused on the relief he felt when Dr. Mills walked in, already scrubbed and ready to start prepping the patient. She was all business, didn’t like to waste time, and didn’t mind getting in there to help out the techs and nurses. She’d been a PA first and then went to medical school. If there was anyone who he trusted, it was her.

“Castiel,” she said sharply, bringing his attention back to reality. “What are the flows?”

“He’s getting about three liters now, but it’s down from this morning where he was at four and a half.”

“Fluid-related?”

Cas shrugged his shoulders. “It could be, if there’s internal bleeding around the trach.”

She looked back again at Sam as she finished gowning. Cas knew he had to speak up, it was up to him to bring their attention to any issues. He had to get over his nerves and anxiety about being the new guy, even if he was wrong.

“Also, I’m worried all his movement today may have misaligned his cannula.”

She nodded slowly in agreement. “Let’s make sure we get X-ray in here,” she told the circulating nurse, Bobby.

Cas felt a nudge at his elbow and turned around, coming face-to-face with Michael. He felt annoyance surge up. This guy was a hot-shot, all the nurses loved him and most of the doctors, too, but he was so arrogant and usually left half of his work to others. It didn’t help that Michael was his brother.

“What the hell took you so long?” Cas hissed.

“Better question, Castiel, is why are you even here? I thought you were off tonight.”

“I was nearby and they called me because they couldn’t get a hold of you.”

His brother made a clicking sound beneath his breath. “Don’t tell me you’re getting attached, Cas.”

Castiel glared at his brother. He knew what was coming next.

“Isn’t that why you left medical school? Didn’t you learn your lesson?” He said it with such malice, the constant reminder of one of the hardest decisions of his life.

“Shut up, Michael,” he said, fighting to keep his voice even and calm. “You should have been here when they paged, and you know it.”

Michael shrugged. “But you were, so it worked out.”

Cas balled his fingers up into fists and fought the urge to punch his brother in the face.

“I have it from here, Cassie, if you’d like to go update the family,” Michael said with a smirk. He knew Cas too well still, he knew that Cas had logged extra hours in Sam’s room and it probably didn’t take a genius to figure out that Dean had something to do with it.

Instead he ignored his brother and left the OR, ripping off his mask as he entered the hallway. His breath was coming in ragged and the tension built up in his shoulders was excruciating, radiating up the back of his neck.

He was aimless, unsure of if he should wander back into the OR room and deal with his brother once again, or maybe he should just go home. Or go talk to Dean.

His feet carried him towards the family waiting room, where he’d first met Dean only two weeks earlier. Cas knew it was silly, that it was just like his brother said: he always got too attached to his patients and it was why he avoided them. It was why he’d never learned how to deal with them.

Then he met Dean, and it suddenly felt so easy. It was unfair.

Castiel gently opened the door the family room and his eyes fell on Dean, head hung down low as he leaned forward in a chair. The door clicked behind him and Dean’s head shot up, eyes wide and watery.

Dean stood and threw his arms around Cas’ neck, pulling him in for a tight hug, one that Cas suspected Dean needed more than anything at that moment.

“Thank god you’re here, man,” he said as he pressed his face into Cas’ shoulder before pulling away.

“Of course I’m here, Dean.” It was all he could muster out, as his skin felt alive from where Dean had touched him.

Dean looked like he was torn between laughing and crying as he looked at Cas and shook his head. “I feel like I should be asking how Sammy is, but just from how you’re standing I can tell you aren’t that worried.”

Cas tilted his head to the side in slight confusion. It was true, Sam was actually no longer a large concern since they had transported him, and he knew he was in the hands of a great surgeon and team; as much as he hated to admit it but his brother was good at his job.

Dean’s shoulders seemed to relax as he shook his head in disbelief. “I figured if you had bad news, this would be all different,” he said as he waved his hands around. “I’d be pulled into a private room and you’d have to sit me down first.”

A small smile lifted at the corner of Cas’ mouth. He had to admit, Dean was right. He shrugged his shoulders in slight affirmation of Dean’s suspicions. “I can’t make any promises but I’m pretty sure Sam is okay,” he said softly, realizing that he and Dean were still standing very close to one another. Close enough to smell the cheap Irish Spring soap on Dean’s body, most likely from a shady motel nearby. He noticed the freckles that sprinkled lightly across the bridge of Dean’s nose.

He found himself licking his lips subconsciously as he reveled in the way that Dean managed to both calm one part of him while simultaneously setting another part on fire. A woman across the room coughed and Cas became acutely aware of a man nearby, flipping through some newspaper pages and two women in the corner, one of them talking quietly on her phone.

Castiel stepped back, embarrassed. Dean was straight and simply needed a friend while his brother was in the hospital. It would be wrong of Cas to take advantage of it or even misconstrue it as anything else.

 

\----------------------------------------------------------------------------------------------------------------------------

  
**December 15, 2016**

 

Dean sat across the faux wood table from Cas in the cafeteria, hunched over a burger that Cas probably wouldn’t have dared to try.

Sam was doing well. They’d completely removed his trach and with a little healing, it seemed like he’d be on his way to at least being able to talk again soon. As Cas had suspected, they’d needed to readjust his ECMO cannula but everything had been going well, in fact the fluid in Sam’s lungs had subsided a great amount. No one wanted to jinx anything yet by mentioning weaning him from ECMO but it was certainly the next big hurdle.

It had just been by coincidence that Dean had come downstairs to the cafeteria, and Castiel couldn’t help but enjoy the way Dean’s face lit up when he saw him sitting in the corner next to the window, far from the poorly assembled hospital Christmas tree, eating his salad. Cas wasn’t one to be rude and turn down some company during his lunch break. Particularly company from an attractive man with bright green eyes and the longest eyelashes he’d ever seen.

“So you’re doing an open heart today?” Dean asked, before taking a large bite of his burger.

“We’re done already, actually,” Cas said with a smile. “It was just a two vessel CABG so it went pretty fast.”

Dean looked at him, raising one eyebrow. “You know I have no clue what you just said, right. Something about cabbages?”

Castiel couldn’t help but chuckle. “Coronary artery bypass graft,” he clarified, eyeing Dean’s burger once again.

“You mean what I’m heading for by eating all my favorite things like burgers and pie?” Dean said chuckling.

“Pretty much.”

Dean shrugged and took another large bite, “I’m sure you’ll take good care of me and my cabbage.”

Cas couldn’t help but laugh, unexpectedly. He wasn’t sure if it had been intended as an innuendo but it certainly sounded like one.

Dean beamed back him, his lips closed over a large mouthful of food but a wide grin across his face.

“So you said before, you’re a mechanic?” Cas said, reaching for his bottled water.

Dean nodded. “I am. I work at a friend’s garage in Kansas, but uh, it’s kind of up in the air right now.”

Cas cocked his head inquisitively. “How so?”

Dean waved his hand around. “All this stuff with Sammy. I mean I know we’re not talking about it yet and I’m not supposed to get my hopes up,” his eyes met Cas’ for reassurance. “But rehab is going to take a while, right?”

“Yes, rehabilitation can take up to a year.”

Dean let out a low whistle. “I can’t just leave him here. He’s got no one else out here.”

Cas nodded. “I agree, it would be good for Sam to have someone here.” He could have told Dean that Sam could transfer back home to Kansas but he knew that he was selfishly hoping that Dean would stick around.

“It’s just complicated, is all.” Dean said with a sigh.

Castiel looked away from Dean as he noticed a young woman with long brown hair walking over to their table. She was pretty, with tan skin and long legs, and her eyes lit up as she picked up her pace, running over towards them.

“Dean!”

Dean turned around and his eyes widened in surprise as a large smile covered his face. “Lisa!” He enveloped her in a hug immediately. “What are you doing here?”

Castiel’s heart sank. Maybe this is the part that was complicated. He knew he was dumb to get his hopes up but it didn’t mean it hurt any less.

Dean turned around, suddenly remembering Cas. Castiel stood up, pushing out his chair with a loud scrape against the linoleum floor. “This is Cas, he’s one of the guys taking care of Sam.”

The woman, Lisa, looked over at Cas and her eyes widened as she shook his hand. “Thank you so much.”

“So what are you doing here?” Dean asked again as he kept his hand on her forearm.

Castiel watched them closely, each movement another painful pang in his heart.

“Your dad told me, he was home a few days ago and mentioned that Sam was sick.” Dean’s smile turned into a scowl and he dropped his hand.

“I’m sorry, Dean. I know he hasn’t been here but he looked like a wreck.”

Dean shook his head. “That sounds like him,” he spat out bitterly.

Lisa grabbed Dean’s hand once more and gave it a tight squeeze before looking over at Cas again. He felt like he was intruding.

“I’m sorry if I was interrupting something, just the nurses told me you were down here eating and I can’t go see Sam without Dean’s permission so,” she trailed off.

Castiel saw his opportunity to escape, to leave with his tail between his legs. “No, I think we’re done,” he replied, gathering his half empty bowl of salad and his water bottle. He ignored the strange look Dean gave him.

“I’ll see you later, Dean.”

“Okay, see ya, Cas.”

Castiel dumped the remnants of his lunch into the trash as he walked away, turning around once to see Lisa and Dean sit down and talk with their heads huddled together. He’d been silly to think anything of the flirtatious jokes Dean made.

 

\----------------------------------------------------------------------------------------------------------------------------

 

**December 18, 2016**

 

Castiel tried to hide his surprise as he stepped inside Sam’s room and was greeted with two smiling faces. Sam was awake, with no intubation tube and no trach either. It was a little risky but given the complications last time, he’d agreed with the plan.

He knew Sam had been awake for a few days, that he’d been working his way up to talking, with only a few words allowed each day. Most of them were saved for his evaluations and therapy, as usual, but it was still always surprising to see one of their patients awake and aware.

The ECMO cannula was still taped to the side of his head, he was certainly much thinner and his hair was stringy and long against his head. A million catheters and lines were hooked up, but it made a huge difference to see him awake. Castiel’s chest surged with pride. They lost a lot of patients on ECMO, and it was always hard, but the good outcomes were worth it.

Cas stepped forward immediately, ignoring Dean for a moment as he addressed Sam. “We met before, Sam. I’m not sure if you remember but I’m Castiel.”

Sam smiled and made a few guttural sounds as he cleared his throat slightly. It was still swollen and sore. “I remember,” he said in a raspy voice.

Castiel beamed.

Dean reached over and placed his hand on his brother’s shoulder. “I’m gonna run back to the hotel and grab a quick shower, now that Cas is here,” he said gently.

Cas looked over at Dean, noting the shadow of a beard around his jaw and that his hair had also begun to grow out from the crew-cut he’d had the first night they met. Dean’s hair was longer, messier, and currently sporting a cowlick that rivaled the one Cas had every morning.

Sam cleared his throat again. “You reek, go shower.” It was clear he was struggling to talk still, with a small grimace at the end and the need to clear his throat every time. His short response was enough to get a grin from Dean though. It seemed like playful banter was a part of their relationship, which didn’t surprise Cas one bit.

Dean nodded at Cas before shrugging on his coat and grabbing his keys from the windowsill. “I’ll be back in an hour or so.”

“Take your time, Dean.” Cas said, knowing that Sam would want him to, which was apparent from the way Sam rolled his eyes as Dean rushed around to grab his things.

“He trusts you,” Sam said the moment Dean left.

Cas looked over at Sam, his eyes warm. “I’m glad. Our patients’ families need to trust us.”

Sam shook his head slightly, careful not to move too many of his lines. “Dean doesn’t trust anyone.”

Cas looked at Sam in confusion. He didn’t want to ask him to elaborate, Sam looked like he was already in need of some ice chips for his very dry mouth. Instead he shrugged, hiding his urgent need to ask Sam what in hell that meant. Dean certainly seemed like he trusted Lisa, and he had a good rapport with all the doctors as well.

“Thank you for taking care of him,” Sam said as he closed his eyes. It was quiet, a whisper almost but Cas heard it. He could tell by the rise and fall of Sam’s chest that exhaustion had won out. Castiel sat back in his chair at the computer and began to chart on Sam’s progress, ignoring the small flutter in his chest. He knew it was pointless, but that didn’t mean he couldn’t hold onto that feeling just a little while longer.

 

\----------------------------------------------------------------------------------------------------------------------------

 

**December 21, 2016**

 

“Winchester, John Winchester.” Cas heard a loud voice say with an annoyed tone, the voice gruff and deep. He gripped the edge of his coffee mug and continued past the front desk of the hospital, slowing down just a bit to get a glimpse of the man.

He knew the name Winchester of course, but there was no mistaking it, this was Dean and Sam’s father. He was tall, handsome in a rugged way, with a dark beard and dark hair. He also looked tired, worn-out, and had dark bags under his eyes.

“My damn son is here and I’ve gotta stand around waiting for a goddamn visitor’s badge to see him?”

The older woman at the counter glared back at him but kept quiet. Cas felt bad for the volunteers. Sick people meant family members who were often upset, angry, you name it. They’d had to tighten up their protocols as well recently, after there were a few unwelcome visitors. All visitors needed to have name badges before stepping foot in any wing of the hospital, and all were escorted to the proper rooms.

Cas climbed the stairs slowly, looking once more at the man who tapped his fingers in annoyance on the counter and looked like he’d spent the previous night drinking. He realized that he should hurry to Sam’s room, because he didn’t know much about their family but he knew that every time Dean got a call from their dad, he tensed up and usually returned to Sam’s room angry and upset.

The fact that Sam had been in the hospital for nearly a month without a visit from his father said enough to Cas about the man. He was no stranger to absent fathers; although his own homophobic religious nut of a father was a different matter as well.

He didn’t stop in the office first, he already knew he was scheduled to work the ECMO shift in Sam’s room. Instead, he kept his messenger bag slung across his body and his empty coffee mug in his hand as he strode quickly towards the ICU.

Cas was slightly out of breath when he reached Sam’s room and pulled aside the clear glass door and the curtain behind it. Dean was watching Dr. Sexy M.D. as usual and Sam was on his phone, texting.

“Dean,” he said, motioning for Dean to come over to the doorway.

Tessa was inside the room still, sitting at the computer and she gave Cas a puzzled look. He was a little early, since he had planned to have breakfast in the office before going over to ICU for shift change.

He ignored her and the look on his face must have been enough because Dean got up without saying a word. Cas closed the door behind them gently before turning towards Dean.

“I think your dad is here.”

Dean gave Cas a pained look. “Please tell me you’re fucking joking, Cas.”

“I wish I was. Is his name John?”

“Fuck.” Dean dragged his hands slowly down his face.

“Should I tell security not to let him up, or?” Cas trailed off. He wasn’t sure what the problem was but he knew Dean and his father did not get along.

“It’s complicated,” Dean said. “But he’s allowed to see Sam I guess. It’s me he doesn’t want to see.”

The pained look in his eyes was all the justification Cas needed to hate John Winchester.

Cas nodded slowly. He put his hand on Dean’s shoulder to reassure him. “Well, I’ll be in there,” he said, hoping that helped.

“Dean.” A gruff voice behind them made Dean jump and step away, while Cas’ arm fell limply back to his side.

“Where’s your brother?”

Dean’s hands clenched into tight fists at his side as he motioned towards the door. Cas went in first, letting Tessa know he’d go over the shift report with her soon. She left the room, not needing any prompting as she noted the tension between the men.

John stepped inside the room and stopped, his eyes taking in all the machines still connected to Sam. Despite his reservations about the man, Cas knew he still had to do his job. He reached out his hand towards John.

“I’m Castiel, I’m the—” but John waved him away.

“Isn’t nursing more of a woman’s job,” he stated bluntly. “Or are you a fairy?” John’s voice dripped with disgust as his eyes lingered on Castiel’s bag for a moment.

Castiel felt the familiar burn of anger beneath his skin and took a deep breath to calm himself. He looked down at his bag, with a pride flag pinned to the front of it and instantly regretted not dropping off his stuff in the office.

“I’m not a nurse,” Castiel said slowly. “I’m a perfusionist and I’d be happy to go over my job duties for you if you’d like,” he said coolly. “But to keep it short, I’m in charge of the machine that is keeping your son alive.”

He caught Dean’s eye from behind John and noticed the amused grin that replaced his horrified look.

John stifled a bit and mumbled under his breath but shook his head at Cas. He got the picture.

Sam finally spoke up, cutting into the awkward silence.

“What took you so long?”

Cas instructed John about staying away from the ECMO machine and away from the lines and he finally looked like he was intimidated, most likely not by Cas but by all the machines around the bed and the dull sound of beeping from the monitor every so often.

John settled into the chair where Dean normally spent his days and patted Sam roughly on the chest. Cas wanted to tell him to be gentler but a look from Sam told him it was alright.

“Been busy kid, work, you know.” He ignored the stern look he got from Sam. “I figured Dean was just being dramatic, but I mean, you look real good so I’m glad I didn’t worry for no reason.”

“I almost died, Dad,” Sam said, glancing over at his brother.

Cas glanced over at the monitor as he watched Sam’s blood pressure slowly begin to climb. Sam’s hands clenched near his sides and while he could speak a lot easier now, his voice still had a rough edge to it. He was thin and pale, no longer the muscular boy they’d first brought in. It amazed Cas that their father just couldn’t see it. Denial could be a strong thing.

“Look, I’m glad you’re okay Sammy,” John said. “But you know I hate hospitals, I haven’t stepped foot in one since your mother.” His voice trailed off.

“I needed you. Dean needed you,” Sam said, unforgiving. “You reek of whiskey as usual, Dad.”

John stood up, slamming his hand on a nearby table. “I’m still your father dammit, and you don’t speak to me that way, no matter how sick you are, boy.”

Cas stepped forward as Sam’s monitor began to alarm loudly. Dean stood by the other side of Sam’s bed, glaring at his father.

“I think you should wait in the family lounge,” Cas said to John as he muted the monitors. “Sam needs to rest.”

John glanced at him for a moment and back at his sons with apparent disgust. “Fuck it. This was a mistake anyway.” He turned and pointed a finger at Dean, “You can get your shit out of my house.”

As John left the room, Dean called out behind him, “The house I fucking pay for!”

Dean leaned back against the wall and closed his eyes, letting out a deep breath. “I’m sorry, Cas.”

Cas patted his shoulder gently, “Don’t be. I know what it’s like to have an asshole for a father.”

 

\----------------------------------------------------------------------------------------------------------------------------

 

**December 23, 2016**

 

Castiel wrapped his navy scarf around his neck as he slowly buttoned his gray wool peacoat. He had a later shift that morning which allowed him the time to stop at a local coffee shop near the hospital. It was usually filled with people in scrubs, rushing around to get their coffee before their shifts started. He enjoyed the atmosphere; it got him excited for his day, reminded him that he had a purpose.

It wasn’t too cold out but it was snowing. Small white flakes flurried around him as he stepped outside and his scarf blew up into his face from the wind. As he reached up to pull it down, he bumped into a solid body.

“I’m sorry,” he said quickly before looking up at the face.

“Cas!”

“Dean!” Castiel laughed in surprise, smoothing down his scarf beneath his coat once more. His eyes traveled up and down Dean’s body, noticing that he wore a black peacoat, which was surprising, but he lacked anything to keep his hands or his head warm. Dean’s cheeks were flushed pink from the cold and one hand was shoved deep in his pocket, the other was pink and clutching his cell phone.

“Are you on your way to work?” Dean asked.

Cas lifted up his coffee cup. “Yes, just stopping for some fuel.”

Dean chuckled. “I’ll walk with you. If you’ve got the time to wait for me to order.”

Cas didn’t even bother to check the time. He knew he’d give anything to spend extra time with Dean, especially since he knew Sam was doing so much better, this might be the only chance he’d get before saying goodbye. “Sure, Dean, I’ll wait.”

Dean grinned as Cas followed him back inside the coffee shop and waited with him in line.

“Are you in Sam’s room today?”

“Unfortunately, no. You’ve got Charlie though, and she’s great.”

Dean’s face seemed to fall slightly. “Yeah, I really like her.” He bumped against Cas’ side gently. “I’d still rather have you though,” he said with a small grin.

Cas’ face flushed and his heart began to flutter in his chest. He looked down at the floor, happy for the distraction of being next up to order. Dean just ordered a black coffee, which Cas had a feeling was because he didn’t want to make Cas late to work. On more than one occasion, Cas had seen Dean fill up his coffee with multiple sugar packets and creamer.

As expected, Dean’s order was ready quickly and they stepped back outside in comfortable silence. They were only a few blocks from the hospital so they had plenty of time. Cas realized this was actually the first time he’d ever seen Dean outside of those walls.

“It’s weird seeing you outside of the hospital,” Dean said, as if he’d read Cas’ mind.

Cas chuckled. “I agree. I was surprised to see you in a peacoat.”

Dean looked down at his coat and his cheeks reddened slightly. “This is actually Sam’s, so it’s kinda big. I had to raid his dorm room for a few things.”

“It looks nice,” Cas said with a nod, taking a sip of his coffee.

“Thanks.”

“You’re spending Christmas here, I assume?” Castiel ventured to ask as they passed by a department store window decorated to the brim with green and red glittery ornaments and gift-wrapped boxes.

“Of course,” Dean said with a shrug. “Not like I’d waste time with my dad when Sammy is here anyway.”

Cas nodded slowly.

“What about you? Where’s your family?” Dean looked over at him before sipping his coffee slowly as they walked.

“They’re… Well, it’s complicated. They live in Boston.” Castiel said with a small shrug. “My father is difficult, to say the least. We don’t get along.”

“I can relate,” Dean said with a chuckle, which Cas couldn’t help but return.

“My brother lives here, but he’s pretty much a carbon copy of my father, so.”

“So you’d rather not spend it with him anyway, right.”

“Pretty much,” Cas said. “Plus, I’m new and I don’t have this holiday off. So suffice to say, my Christmas plans will include hospital food and stealing snacks from the nurses’ lounge.”

Dean chuckled. “The only thing I miss about Christmas at home is homemade cookies. My mom used to make the best peanut butter cookies.”

It was the first time Dean had ever mentioned his mother but from what his father had said, Cas had assumed she’d passed away. He looked at Dean.

“They sound amazing.”

Dean nodded and took a deep breath. “She passed away when I was little. House fire, and they got her out and she was in the hospital for about a week, but I guess she was too badly injured.”

“I’m so sorry,” Cas said softly, thinking of his own mother who he hadn’t spoken to in years.

“It’s okay,” Dean said, “I mean it sucks but I couldn’t turn into my dad. He never got over it. You have to keep on living, you know?” A gentle smile pulled at his lips as Dean took a deep breath and then took another large sip of his coffee. Castiel fell harder for him with each passing second.

Cas looked back over at Dean as they walked, their elbows bumping occasionally in their comfortable silence. Dean’s lashes had small snowflakes across them and his hair was covered in it. His lips were slightly chapped but bright pink and pouty. He didn’t think it was possible, but Dean looked even more gorgeous outside of the fluorescent lighting of the hospital, with his green eyes shining from the cold. Cas noticed for the first time that his eyes had flecks of gold in them as well. He was simply gorgeous.

“Do you live around here?” Dean asked, suddenly breaking the silence.

The question surprised him, as it often did when Dean asked about his personal life, which was becoming more and more common.

“I do, in a small one bedroom a few blocks the other way.”

“Just you?”

“Me and my dog, Ahri,” Cas said with a smile as he pulled out his phone. “Want to see a picture?”

Dean laughed. “Sure, although I’m not really a pet kind of guy.”

Cas scowled at him. “I thought I was going to adopt a cat. Somehow I wound up with her.” He pushed his phone towards Dean, showing a picture of him and Ahri last year when he’d first adopted her.

“That’s a really cute picture,” Dean said as he looked at it. “I like your glasses,” he said as he looked up at Cas again.

Cas groaned. “I almost never wear them, I forgot I had them on in that picture.”

“I like them.” Dean said with a small grin. “Although you have really blue eyes, so I can see why you’d rather wear contacts.”

“Okay, now you’re making me self-conscious,” Cas said as he knocked into Dean’s side lightly.

Dean chuckled but didn’t say anything else. Cas wasn’t sure exactly what to say either, so they continued to walk in silence as a warmth spread throughout Cas’ body and made his fingertips tingle.

He’s not into guys. He’s just being friendly, Cas reminded himself mentally, which didn’t do anything to stop the butterflies in his stomach as they walked and the way that his words felt caught in his throat each time he wanted to just flat out ask Dean ‘are you flirting with me or am I just being stupid?’

 

\----------------------------------------------------------------------------------------------------------------------------

 

**December 25, 2016**

 

Cas felt the familiar pinprick of anxiety at the nape of his neck as the room filled slowly with a few doctors, techs, and nurses. Sam was sedated again, paralyzed just temporarily as the procedure was done.

It was Christmas. And Sam was coming off ECMO.

They had begun the process of weaning him the day before and throughout the night and Sam’s lungs had finally recovered enough to let him begin to breathe and oxygenate his blood on his own. The settings were all turned down on the ECMO machine and Sam’s saturations had held steady. His X-rays finally looked clear and even Cas felt confident that this was the right move.

It didn’t mean he wasn’t nervous though. Once the cannula was out, it would be up to Sam’s body to start doing all the hard work again.

Castiel looked over at Dr. Talbot as she prepared to remove the cannula, placing a few sutures first. They were in the ICU, hoping to make this a quick and painless transition.

“You can clamp out, Castiel,” she instructed.

Castiel first placed a clamp on the arterial line and then venous line, before he turned down the flow on his machine. Sweat lined the inside of his gloves and he watched Sam’s monitor with trepidation.

Dr. Talbot pulled the cannula out and pulled her sutures tight. Other than one small spurt of blood against the wall and onto her gown, it was smooth. Sam’s pressures held steady and as Cas chased the rest of Sam’s blood from the circuit back into him, everything went as well as he could have hoped. As he finished cleaning up and pulled the ECMO circuit from the room, a wave of relief hit him as well as one of sadness.

He had done his job. It was over. Sure, he had to clean the circuit and do tons of paperwork. But they had done it, they’d saved Sam. Of course it didn’t mean Sam was out of the woods; he still had lots of physical therapy to go through. But Cas’ part in it was complete, and in the end it was all he could ask for that his patient would have a good outcome.

And yet, it meant that his days would no longer be punctuated by his interactions with Dean. They’d formed a habit of watching Dr. Sexy, M.D. together late at night or getting lunch together while Sam did his therapy. He knew it was the natural way of it, but Cas felt a deep sadness at losing the only real friend he’d somehow made in a year in this city. Worse, it was someone who lived a couple hundred miles away and would be leaving soon.

He pulled the ECMO cart into the storeroom and leaned against the wall, taking a deep breath and closing his eyes.

“It feels good, doesn’t it,” a British voice said to him, gently. “When ECMO works.”

He looked up and met eyes with Dr. Talbot. “I’m really glad Sam is doing well,” he said with a smile. It wasn’t a lie either and he felt selfish for the part of him that was sad about no longer needing to be there to treat him.

“I gave Dean the news,” she said nonchalantly. “And he asked to see you.”

Castiel just looked at her, wary of her motives.

“Don’t go thinking that you’re my favorite around here or anything.”

He opened his mouth to reply but she stopped him.

“Sam Winchester is no longer your patient.” She paused for a moment, letting her words hang in the air. “Merry Christmas, Castiel.”

Castiel looked at her in confusion, his eyebrows furrowed. He stood up straight and walked towards the private waiting lounge where he knew Dean was waiting to see him.

He opened the door carefully, a parallel to their first meeting, and he felt silly for remembering it. After all, they had only known each other a month. His eyes fell on Dean, who was standing next to the window, gazing at the falling snow outside.

“Dean,” he said, his voice gentle.

Dean turned to look at him, a wide smile on his face. “Sammy’s okay.” It wasn’t a question.

Cas nodded and smiled back at Dean even though he knew this was goodbye and every bone in his body ached from the thought of it.

Dean turned around and grabbed something from underneath his coat on the chair behind him. “I hope you don’t mind but I got you something. Call it a thank you gift or a Christmas present, whatever,” he said sheepishly, shoving a book into Cas’ hands.

“Sorry I didn’t get a chance to wrap it, and I wasn’t really sure what you liked but I know you like to read so.” Dean was stammering and he trailed off as he caught himself.

Cas looked down at the book, turning it over to read the cover. “Flowers for Algernon,” he read out loud.

“I wasn’t sure what book to get you and fuck, I didn’t want to get you something you’ve already read but anyway, I just picked one of my favorites.”

Cas quickly skimmed the synopsis on the back cover and looked at Dean, trying not to choke up. “This is wonderful, Dean. I’ve always wanted to read this.”

Dean looked up, his eyes finally meeting Cas’. “Merry Christmas, Cas.”

Dean was constantly surprising Cas, with his rough mechanic hands and casual way of inserting swear words into every other sentence, but he was well-read and soft and gentle in so many other ways. It hit Cas like a ton of bricks all at once. He was falling in love with Dean, slowly but surely he’d been falling in love with a patient’s relative and it wasn’t allowed but he’d done it anyway.

Dr. Talbot’s words echoed in his mind, “Sam Winchester is no longer your patient.”

Cas looked back at Dean, noticing that they were once again standing so close to one another that Cas could smell his cologne and see the nick on Dean’s jaw where he’d cut himself shaving, and Dean’s eyes sparked in the lights of the lazily hung lights strung around the window.

“Dean,” he said, his voice deep and husky. Cas had time to set the book down on the windowsill before their lips collided in a long overdue kiss. Dean’s hands skated down Cas’ back as he pulled them flush together.

Cas pulled back for one moment, instantly missing Dean’s lips on his. “What about Lisa? I thought you were—?”

Dean started to laugh. “Lisa’s just a friend. She lived next door and we grew up together.”

“I thought you were… I didn’t think that you were into men,” Cas started to say.

“I’m… not sure I guess, but I think I’m into both” Dean replied sheepishly. “My dad caught me with a guy at a bar about six months ago and we haven’t spoken since. I’ve been trying to figure it out but I’m not too worried about it,” he said grinning.

“So I wasn’t crazy,” Cas mused out loud.

“Dude, I was flirting like mad with you,” Dean said with a laugh as he pulled Cas in again. “I just didn’t want to get you fired or anything.”

“What about Sam?”

Dean scrunched up his nose. “I didn’t tell him, that’s for damn sure, but I’m almost positive he knows anyway.”

Cas chuckled before winding his hands through Dean’s hair and pulling him down for one more long, drawn out kiss, their chests heaving against one another.

“Merry fucking Christmas, indeed,” Dean said into Cas’ ear.

 

\----------------------------------------------------------------------------------------------------------------------------

 

**Dec 31, 2016**

 

Cas straightened his tie in the mirror once more, looking over at Dean who was doing the same. It was the annual hospital charity New Year’s Eve event, which he had skipped last year. However, seeing as Dean was already going to most likely be at the hospital with his brother, it seemed easier to just ask him to attend and then spend the night with Sam, who had moved to a step-down room out of ICU.

Dean grinned at Cas and slapped his ass, telling him to hurry up so they could get to eating their fancy catered food. Cas was nervous, that was for sure. He’d cleared it with his boss and Dr. Talbot that he could be open about a relationship with Dean, and while unprecedented, they saw no real issues with it since Sam was no longer his patient.

He’d gotten lucky with it, having Charlie on his side, and his brother had been unusually quiet about the whole thing which was more than Cas could have hoped for. He finally felt alive, like he’d been pulled out of a gray painting into one with color and life in it. Dean made him feel that way, even on his worst days, which he still had of course because who doesn’t.

Sam had had a few setbacks, some days where Dean sulked the entire time but at the end of the night, the two of them somehow always wound up on the same page. Cas could feel himself blushing as he looked at Dean again, admiring the way his suit hugged his chest and the dark green tie brought out the color in his eyes.

“You look really nice, Dean,” he said.

“You clean up good too, Cas,” Dean said with a mischievous look in his eyes.

Cas rolled his eyes and pushed Dean towards the door. “We’re not fooling around in a hospital bathroom,” he said, knowing full well that they’d barely been able to keep their hands off of each other for a week.

Dean spun around and kissed Castiel on the mouth quickly before stepping out into the main lobby of the hospital, which was decorated with large gold and black balloons and jazz music wafted over the speakers.

Dr. Mills strode by them and winked at Cas. “Looking good there, Cas,” she said before pausing and looking at Dean. “I don’t think I want to ask.” She laughed as she grabbed a glass of wine from a waiter walking by. “Have a nice night, boys!”

Castiel laughed and shook his head. “That was the chief of cardiac surgery.”

Dean pretended to whistle in awe but his eyes were still glued to Cas, and a goofy smile was on his face.

“What?” Cas asked, self-conscious.

“I’m happy, is all,” Dean said with shrug. “I guess a few months ago I couldn’t have pictured this.”

Cas wrapped his arms around Dean’s neck and bent his head towards Dean’s. “I’m really happy you’re staying here,” he said a little breathless.

“Me too,” Dean said as he kissed the tip of Cas’ nose.

They attempted to dance to a few songs, but Cas was a terrible dancer and after a few glasses of wine they both were flushed and hot. It was the most fun Cas had had since moving to Chicago.

“We’ve still got some time before midnight,” Dean whispered into Cas’ ear, licking it slowly and seductively.

Cas’ dick immediately twitched in his dress slacks and he looked around in alarm at all his nearby co-workers. Dean placed one hand in Cas’ back pocket and pulled them together tightly as the music changed to a slow song.

Dean looked at Cas, lowering his lashes as his eyes traveled down Cas’ body. Cas tried to be annoyed but he was mostly amused.

Cas grabbed Dean’s hand and began to pull him away towards the elevators.

“What are we—?” Dean trailed off.

The elevator doors closed and Cas pushed Dean against the wall, kissing him fervently as he rolled his hips against Dean. When the bell dinged, they pulled apart and Cas thanked god that the floor was empty because he was rock hard and when he looked over at Dean, he looked just as wrecked, with his pupils large and lips swollen from Cas biting them.

Cas didn’t waste a moment, grabbing Dean by the wrist again and pulling him down the hallway. They stopped in front of a door and Cas used his keycard to open it, as Dean’s face broke into a very wide grin.

“The on-call room,” he said with excitement.

Cas closed the door behind him and locked it, turning around with a large grin.

Dean stepped close to him, gently pulling Cas’ jacket off and letting it drop to the floor. Dean took his time, leaving Cas’ tie on as he slowly unbuttoned each button on his white shirt. It was excruciating and Cas was rock hard by the time Dean had finished.

“You’re still fully clothed,” Cas said in a deep voice, as he pushed Dean towards the bed. The back of Dean’s knee hit the bed and he sat down, grinning up at Cas.

“Sounds like something you should fix.”

Castiel climbed over him slowly, draping his body over Dean’s as he pushed Dean down onto the bed. He sat back on Dean’s lap and looked down at Dean with a smirk as he began to undo Dean’s buttons, rolling his hips forward each time.

“Fuck, Cas,” Dean breathed out as he scrunched his eyes shut, his hands on Cas’ ass.

Dean reached up and grabbed Cas’ tie, bare against his chest, and pulled Cas down to kiss him, licking his tongue inside Cas’ mouth only to then suck hard on the bottom of his lip. Cas moaned deep in his throat and closed his eyes.

When Dean let go of his tie, Cas sat back on his heels and helped Dean pull his pants off and shove his boxers onto the floor. Dean’s cock lay thick and hard against his skin and Cas leaned down, biting into Dean’s chest and sucking hard as he rolled his hips against Dean’s cock. Dean breathed in and shuddered, arching his body upwards.

Cas got to Dean’s hips and dug his fingers into Dean’s sides as he held Dean still, licking slowly down and taking Dean’s dick into his mouth. Pre-come leaked down the sides and Cas ran his tongue up the shaft as Dean squirmed beneath him. Cas had never seen someone so beautiful.

Cas wrapped his lips and one hand around him, sucking and licking slowly while Dean came apart beneath him. Cas had removed his own pants as well and began to pump his own dick as he sucked on Dean’s. It was almost enough to make him come when Dean moaned loudly.

“Dean,” he said as he sat back, squeezing Dean’s cock at the base.

Dean opened his eyes, his face and neck flushed red. His breath was ragged and he was begging for more.

“I brought lube,” Dean said as if reading Cas’ mind. “And don’t worry, it’s not my first time,” Dean said with a wink. They hadn’t had the discussion yet but Cas was relieved and excited all at once.

Cas leaned over to grab Dean’s jacket from the floor, finding the small bottle at the bottom of an inside pocket. He tossed it onto the bed and climbed back on, leaning down to kiss Dean once more.

Dean grabbed at Cas’ cock himself and began to stroke it, his fingers wrapping around the tip and then slowly back down the shaft. Dean would twist slightly, sending a flame of sensation down Cas’ spine from the mix of pain and pleasure. Cas closed his eyes tightly, “Dean,” he murmured at each thrust into Dean’s hand.

When Dean slowed down, Cas opened his eyes and looked down at Dean, smiling with joy. “Is this okay?” he asked, placing lube onto his fingers.

“For fuck’s sake, yes,” Dean said with exasperation. “I’m so hard it fucking hurts,” he laughed.

Cas grinned and leaned over Dean, pressing into Dean’s ass slowly with one finger and he watched as Dean’s face scrunched up and then relaxed into it. They took their time, Cas exploring what made Dean writhe in pleasure. He moved one finger in and out until Dean was begging for more, sweat glistening on his chest and flush on his cheeks.

Cas slid in a second finger, and began to stroke his own cock again as Dean fell apart beneath him. Dean began to move in time with Cas’ fingers, moaning at each thrust.

By the time Cas slid in a third finger, Dean was begging him to just use his dick, his voice coming out breathless. Cas worshipped the way Dean said his name, his eyes squinted shut and his nose scrunched up slightly. Cas dragged his hand up and down Dean’s chest, stopping to twist at his nipples, which earned him a whole new sound from Dean. His fingers moved down Dean’s tight chest to the soft skin just above his hips.

Dean thrust once more onto Cas’ fingers and opened his eyes to look at Cas. They were wide and filled with so much wanting, and so much trust.

After quickly digging for a condom in Dean’s discarded pants, and putting it in with anticipation, they were both ready. Cas moved in slowly, pushing his cock in gently with just the tip and watched Dean’s face to see if it hurt.

“I’m okay, you ass,” Dean said, urging Cas to continue. Cas was deliberately taking his time, dragging out every moment as Dean whined and begged to be filled. He felt like his own dick was ready to explode by the time he pushed into Dean fully, earning him a small sound of discomfort and an “I’m fine, I swear,” from Dean.

It didn’t take long for Dean to open up and for Cas’ dick to fit more comfortably, as Dean urged him to move. He pulled out and then pushed back in slowly and Dean moved with him, their fingers intertwined at Dean’s shoulders. Cas began to fuck into Dean hard, ignoring the bed slamming into the wall and the creaks of the mattress beneath them. Cas panted harshly, his chest heaving as he thrusted, and his heart swelled as he looked at Dean and their eyes met.

Dean held his gaze, until Cas started to stroke Dean’s dick where it bobbed against his skin. Cas was close and he wanted them to come together.

“I’m close, Cas,” Dean whispered between breaths.

“I’ve got you,” Cas replied, panting as he tried to keep his hand in motion with his body as he thrust harder into Dean, feeling himself on the edge.

“Fuck,” Dean said as he closed his eyes and came onto his own stomach and over Cas’ hand. It was enough to send Cas over the edge and he came as well, thrusting one last time into Dean and arching his back as he felt the sensation pulse through every nerve in his body, before he collapsed into a sticky mess on top of Dean.

He could hear and feel Dean’s heart racing beneath him and Cas smiled.

“Are you okay?” Cas asked Dean as he slid over to his side, their heads facing one another.

“I think I’m more than okay,” Dean said gently. “I’m happy.”

“Me too,” Cas replied as he placed a chaste kiss on Dean’s lips. “Me too.”

 

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_**END** _


	2. Glossary

**Perfusionist** : A highly specialized healthcare professional who runs the heart-lung machine during cardiac surgeries that require cardiopulmonary bypass. As noted in this story, another responsibility includes ECMO. Perfusionists in the U.S. typically obtain a master's degree, and must pass a two part board examination in order to achieve the designation of “CCP” or “certified clinical perfusionist”. This is a relatively unknown but great profession.

In this story, while Cas does sit ECMO alone, in reality there would most likely be also be a trained ECMO nurse in the room (ECMO patients typically require 2 staff members). This was hand-waived in order to allow Dean and Cas alone time. Depending on the institution, perfusionists do sit ECMO, but not always (for example at my institution we round twice a day on them). 

                                                                                      

 **ECMO** : Extracorporeal membrane oxygenation, a treatment used for patients with life-threatening heart and/or lung problems. It provides long-term breathing and heart support and is used only when all of the standard treatments for those problems have already been tried. ECMO can support patients for days to weeks while doctors treat their underlying illness.

The ECMO machine, often referred to as a “circuit,” is quite large and contains sterile plastic tubing that moves blood from the patient to the “ECMO lung” and then back to the patient. The ECMO lung adds oxygen to the blood and removes carbon dioxide, as a healthy lung would.

There are two types of ECMO. Venovenous (V-V) ECMO is used when the heart is functioning well and only the lungs need to rest and heal. Venoarterial (V-A) ECMO is used when the heart as well as the lungs need to rest and heal.

                                                                                      

 **ECMO cart** : A cart that holds the ECMO circuit, water heater, O2 tank, clamps, and other needed supplies.

 **ARDS** : Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. More fluid in your lungs means less oxygen can reach your bloodstream. This deprives your organs of the oxygen they need to function.

 **Cannula** : A thin tube inserted into a vein or body cavity to administer medicine, drain off fluid, or insert a surgical instrument.

In this story, it is used to describe the Avalon Cannula that is inserted in the right internal jugular vein and through the right atrium. It is used to drain venous return to the ECMO circuit and then through another lumen it returns oxygenated arterial blood back to the heart.

                                                                                   

 **Intubation** : The placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs.

 **Tracheostomy** : A surgically created hole through the front of your neck and into your windpipe (trachea). The term for the surgical procedure to create this opening is tracheotomy.

A tracheostomy provides an air passage to help you breathe when the usual route for breathing is somehow obstructed or impaired. A tracheostomy is often needed when health problems require long-term use of a machine (ventilator) to help you breathe.

 **Flow** : This is referred to several times in the story but it is referring to the flow on the ECMO machine, in L/min going through the circuit. The required flow is determined based on the size of the patient and their needs. Typical flow can range from 3.0-6.0 liters in an adult. Flow needs vary based on what type of ECMO (VV or VA). Lower flows mean that less blood is going through the circuit per minute getting oxygenated. To increase oxygenaton, flow is increased (among other options).

 **CABG** : Coronary artery bypass graft. Surgery where vein grafts are used to re-establish flow down the coronary arteries when the native arteries have become clogged (coronary artery disease) and no longer allow adequate flow through them.


End file.
